Unpacking the impact of adverse childhood experiences on adult mental health.

Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts.

[1]  Holly Hedegaard,et al.  Increase in Suicide in the United States, 1999-2014. , 2016, NCHS data brief.

[2]  Cheryl A. Richey,et al.  Crossing the line from physical discipline to child abuse: how much is too much? , 1997, Child abuse & neglect.

[3]  R. Turner,et al.  Living with psychiatric patients: implications for the mental health of family members. , 1987, Social science & medicine.

[4]  P. Chandler,et al.  Increasing physical activity among young children from disadvantaged communities: study protocol of a group randomised controlled effectiveness trial , 2016, BMC Public Health.

[5]  S. Easton,et al.  Mental health indicators fifty years later: A population-based study of men with histories of child sexual abuse. , 2017, Child abuse & neglect.

[6]  D. Chapman,et al.  Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. , 2002, Psychiatric services.

[7]  Melissa T. Merrick,et al.  Adverse childhood experiences and life opportunities: Shifting the narrative , 2017, Children and youth services review.

[8]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[9]  D. Chapman,et al.  Adverse childhood experiences and the risk of depressive disorders in adulthood. , 2004, Journal of affective disorders.

[10]  D. Williamson,et al.  Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance. , 2004, The Permanente journal.

[11]  D. Hayes,et al.  Adverse Childhood Events and Current Depressive Symptoms Among Women in Hawaii: 2010 BRFSS, Hawaii , 2014, Maternal and Child Health Journal.

[12]  M. Bellis,et al.  Relationships between adverse childhood experiences and adult mental well-being: results from an English national household survey , 2016, BMC Public Health.

[13]  Catherine A. Taylor,et al.  Mothers' Spanking of 3-Year-Old Children and Subsequent Risk of Children's Aggressive Behavior , 2010, Pediatrics.

[14]  H. Tiemeier,et al.  Childhood Experiences and the Risk of remature Mortality , 2009 .

[15]  G. Waller,et al.  Childhood emotional abuse and eating psychopathology. , 2000, Clinical psychology review.

[16]  M. Leboyer,et al.  Preferential association between childhood emotional abuse and bipolar disorder. , 2010, Journal of traumatic stress.

[17]  E. Gershoff,et al.  Spanking and child outcomes: Old controversies and new meta-analyses. , 2016, Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association.

[18]  I. Gottesman,et al.  Impact of depression on quality-adjusted life expectancy (QALE) directly as well as indirectly through suicide , 2015, Social Psychiatry and Psychiatric Epidemiology.

[19]  Erin M. Pryor,et al.  Child Depressive Symptoms, Spanking, and Emotional Support: Differences Between African American and European American Youth , 2008 .

[20]  S. Moss,et al.  Impact of child sexual abuse on mental health , 2004, British Journal of Psychiatry.

[21]  D. Wolfe,et al.  Child neglect: developmental issues and outcomes. , 2002, Child abuse & neglect.

[22]  Melissa T. Merrick,et al.  Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis. , 2013, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[23]  A. Khaleque,et al.  Parental Acceptance‐Rejection: Theory, Methods, Cross‐Cultural Evidence, and Implications , 2005 .

[24]  R. Rohner,et al.  Antecedents and consequences of parental rejection: A theory of emotional abuse , 1980 .

[25]  K. Kendler,et al.  Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. , 2000, Archives of general psychiatry.

[26]  G. Wyatt.  The sexual abuse of Afro-American and white-American women in childhood. , 1985, Child abuse & neglect.

[27]  R. Anda,et al.  Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. , 2003, The American journal of psychiatry.

[28]  J. Sareen,et al.  Childhood emotional maltreatment and mental disorders: Results from a nationally representative adult sample from the United States. , 2016, Child abuse & neglect.

[29]  D. Chapman,et al.  Insights Into Causal Pathways for Ischemic Heart Disease: Adverse Childhood Experiences Study , 2004, Circulation.

[30]  J. Kassel,et al.  Generalized expectancies for negative mood regulation and problem drinking among college students. , 2000, Journal of studies on alcohol.

[31]  D. Chapman,et al.  Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. , 2001, JAMA.

[32]  G. Papakostas.  Major depressive disorder: psychosocial impairment and key considerations in functional improvement. , 2009, The American journal of managed care.

[33]  K. Brady,et al.  Adverse childhood events as risk factors for substance dependence: partial mediation by mood and anxiety disorders. , 2010, Addictive behaviors.

[34]  Melissa T. Merrick,et al.  Preventing child abuse and neglect: A technical package for policy, norm, and programmatic activities , 2016 .

[35]  Brandon E. Gibb,et al.  Childhood emotional, physical, and sexual abuse, and diagnoses of depressive and anxiety disorders in adult psychiatric outpatients , 2007, Depression and anxiety.

[36]  M. Stein,et al.  Relationship of childhood maltreatment to the onset and course of major depression in adulthood , 1999, Depression and anxiety.

[37]  Catherine A. Taylor,et al.  Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience , 2017, Child abuse & neglect.

[38]  M. Bair-Merritt,et al.  Adverse Childhood Experiences: Expanding the Concept of Adversity. , 2015, American journal of preventive medicine.

[39]  Melissa T. Merrick,et al.  Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010. , 2015, American journal of preventive medicine.

[40]  C. Pomerleau,et al.  The effects of a psychological stressor on cigarette smoking and subsequent behavioral and physiological responses. , 1987, Psychophysiology.

[41]  E. Romano,et al.  What Is the Link Between Corporal Punishment and Child Physical Abuse? , 2015, Journal of Family Violence.

[42]  M. Straus,et al.  Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families , 1990, Violence and Victims.

[43]  R. Yehuda,et al.  Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice. , 2003, Child abuse & neglect.

[44]  M. Newcomb,et al.  Development and validation of a brief screening version of the Childhood Trauma Questionnaire. , 2003, Child abuse & neglect.

[45]  Richard J. K. Taylor,et al.  Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review. , 2011, Social science & medicine.

[46]  D. Oslin,et al.  Childhood Adversity Increases Risk for Nicotine Dependence and Interacts with α5 Nicotinic Acetylcholine Receptor Genotype Specifically in Males , 2012, Neuropsychopharmacology.

[47]  M. Boyle,et al.  Slapping and spanking in childhood and its association with lifetime prevalence of psychiatric disorders in a general population sample. , 1999, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[48]  A. Khaleque,et al.  Reliability of Measures Assessing the Pancultural Association between Perceived Parental Acceptance-Rejection and Psychological Adjustment , 2002 .

[49]  C. Brown,et al.  The Role of Family Factors, Physical Abuse, and Sexual Victimization Experiences in High-Risk Youths’ Alcohol and Other Drug Use and Delinquency: A Longitudinal Model , 1992, Violence and Victims.

[50]  W. Boyce.  The lifelong effects of early childhood adversity and toxic stress. , 2016, Pediatric dentistry.

[51]  G. Giovino,et al.  Adverse childhood experiences and smoking during adolescence and adulthood. , 1999, JAMA.

[52]  D. Finkelhor,et al.  Improving the adverse childhood experiences study scale. , 2013, JAMA pediatrics.

[53]  Dale Nordenberg,et al.  Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. , 2019, American journal of preventive medicine.